Hospitalists Share Patient Care Tips, Strategies at HM14 Annual RIV Competition

From: The Hospitalist, May 2014

Research, Innovations, Clinical Vignettes (RIV) posters at Society of Hospital Medicine’s annual meeting showcase daily check-in routines, physicians’ online paging tools

by Richard Quinn

Cathy Jones, MD
Cathy Jones, MD, Wake Forest Baptist Health, talks about her poster.

LAS VEGAS—To an untrained eye, the poster looked a lot like the hundreds of others that lined the exhibit hall here at Mandalay Bay Resort and Casino. But this one belonged to hospitalist Cathy Jones, MD, an associate chief medical officer (CMO) for medical services at Wake Forest Baptist Medical Center in Winston-Salem, N.C.

The poster, “The Daily Safety Check-In: A Strategy For Reducing Serious Harm to Patients,” highlighted the hospital’s use of a daily safety check-in (DSCI) that gathers hospitalists, nurses, infection-control staff, and at least one representative from its CMO office to discuss the patient census. The meeting—held without fail each morning at 9:05, 365 days a year, including holidays—takes at least 30 minutes, time that might seem like too much to some observers who couldn’t imagine squeezing another half-hour meeting into their schedule.

But to Dr. Jones, the DSCI is worth every second, and she wanted—practically needed—to share it. “We think this is saving lives in our organization,” she says. “Maybe somebody else will see this and say, ‘We could do that,’ and maybe it would make a difference there, too.”

Therein lies the point of the annual Research, Innovations, and Clinical Vignettes (RIV) poster competition: hospitalists sharing profound thoughts, creative pilot programs, and unique cases with their brethren from around the country.

“Sometimes you’re so close to a problem, you just can’t figure it out,” says Dr. Jones, whose poster came in second place in the Innovations category. “You keep trying the same old things and they don’t work. Then you come here and you say, ‘Oh, they’ve done some training (on) that problem at our hospital.’ And often you have the opportunity to talk to the person and say, “Tell me, what’s your curriculum? Who teaches it?’... This sharing of ideas is what’s so nice about the poster sessions.”

Lekshmi Santhosh, MD, of the University of California at San Francisco, describes her HM14 poster.
Lekshmi Santhosh, MD, of the University of California at San Francisco, describes her HM14 poster.

Some ideas, such as Dr. Jones’ DSCI, might seem too big to tackle. Others, like a paper presented by third-year internal medicine resident Lekshmi Santhosh, MD, from the University of California at San Francisco (UCSF), can be as simple as an innovative update on how doctors send and receive electronic pages.

Dr. Santhosh’s poster, “CareWeb Messenger: A Facebook/Twitter/Paging Hybrid for Collaborative Care,” showcases a web-based paging tool that combines features of Facebook and Twitter and allows users to send, receive, view, search, and store messages on a patient’s “wall,” while routing each message to a provider’s pager and wireless phone. The idea is to ease the perceived burden of answering pages while also improving communication skills.

The concept resonates well; a panel of judges awarded it the best poster by a trainee in the Innovations competition. And, while Dr. Santhosh was humbly honored, she says talking to other physicians is the reason she was excited to present.

“Somebody from (the University of Pennsylvania) came up to me—totally opposite coast—and he showed me what they’re using, which is basically an SMS text-based system,” Dr. Santhosh adds. “I was sharing ideas with him. I would never have been able to meet him or even hear about what they’re doing at Penn if not for forums like this.”

The ability to crowd-source ideas at the poster competition appealed to Susan Hunt, MD, a hospitalist at Seattle Children’s Hospital and the University of Washington Medical Center and one of SHM’s judges for the Innovations portion of the poster competition. Dr. Hunt says it’s difficult choosing winners because there are so many good presentations, but, more importantly, hospitalists should use the competition as a chance to see the best of the best and then pick out concepts that might work at their hospital.

“How translatable is it?” Dr. Hunt says, listing off judging criteria. “How applicable is it to the general hospitalist population? Community hospitalists? Academic hospitalists? How will this help them provide better care for their patients, better job satisfaction, better training? Some of the ones that didn’t win are still great ideas.”

Take the project presented by a trio of hospitalists from Rush University Medical Center in Chicago. The poster, “Guidelines, Education, and Email Alerts Can Decrease Transfusions in General Medicine Patients,” explained a project to “increase adherence to a restrictive transfusion guideline for patients admitted to general medicine floors.” The intervention suggested a transfusion threshold of Hgb<7 in upper GI bleed patients, except in cases of hemodynamic instability. In all other indications, the threshold was Hgb<8.

The research found that when samples from three months before the intervention were compared with samples collected three months post-intervention, the number of transfused units dropped to 273 from 481. In the pre-intervention sample, there were 95 units of blood delivered with a pre-transfusion Hgb>8; in the post-intervention group, only 18 units were delivered. 

But Rush hospitalist Jisu Kim, MD, FHM, isn’t stopping with a poster. “This is one of the endpoints,” Dr. Kim says. “We want to see how much further we can go. Can this be a publishable paper? What’s the next step for our other projects? We’re getting motivated by it.”

Dr. Kim believes that in addition to sharing information, getting the next generation of physicians involved in the poster competition inspires young physicians to further engage in their specialty. To that end, residents Manya Gupta, MD, and Lesley Schmaltz, MD, say they are grateful to be part of the presentation.

“It’s very rewarding because it makes you want to keep moving forward and keep making those improvements,” says Dr. Schmaltz. “That’s why I think we all do our posters and presentations: to help the greater good of all physicians throughout the country.”

“It’s been a really great learning experience to get your feet wet,” Dr. Gupta says. “You just have to try it out once and find out what it’s like; otherwise it seems so daunting. Then you realize, ‘We can do this.’”

Poster Winners

Research: “Comparative Effectiveness of Hospital-Based Educational Interventions for Patients with Asthma or COPD.” Valerie Press, MD, MPH, University of Chicago Medical Center

Innovations: “The Palliative Care Quality Network: A Quality Improvement Initiative for Palliative Care Services.” Steven Pantilat, MD, University of California at San Francisco

Clinical Vignette, Pediatric: “Why Can’t a Previously Healthy Child Be Weaned Off the Ventilator?” Joanna Parga, MD, Children’s Hospital Los Angeles

Clinical Vignette, Adult: “Abdominal Pain Following

Lap-Sleeve Gastrectomy: A Case of Post-Operative Portal Vein Thrombosis.” Anisha Advani, MD, Brigham and Women’s Hospital, Boston

Research, Trainee: “Pediatric Hospitalist Circumcision Service: Analysis of Rate of Complications.” Corinne Hamvas, MD, Washington University, St. Louis, Mo.

Innovations, Trainee: “Careweb Messenger: A Facebook/Twitter/Paging Hybrid for Collaborative Care.” Lekshmi Santhosh, MD, University of California at San Francisco

Clinical Vignette: A Visitor with a Virus.” Arul Thangavel, MD, University of California at San Francisco

Clinical Vignette: “Crohn’s No Longer: The Importance of Biopsies.” Chirayu Shah, MD, Baylor College of Medicine, Houston

Oral Abstract, Research: “Unintended Consequences of Increasing Pharmacologic Venous Thromboembolic Prophylaxis in Hospitalized Medical Patients.” Scott Kaatz, DO, FACP, FHM, Hurley Medical Center, Flint, Mich.

Oral Abstract, Innovations: “Innovations In Data Visualization To Drive Down Unnecessary Transfusions.” A. R. Rajkomar, MD, University of California at San Francisco


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